JS Festival in Tochigi 1st National Elderly Welfare Facility Conference

What Australian aged care can learn from reducing psychotropic use

The first National Elderly Welfare Facility Conference and Research Meeting, known as the JS Festival in Tochigi, brought together aged-care practitioners, facility leaders, researchers and suppliers from across Japan. Its programme combined research presentations with practical workshops, study tours, networking and an exhibition of products and services. The event’s central value was its focus on changes that can be tested in daily care, rather than ideas that remain in academic papers. The JS Festival Tochigi archive provides useful context for professionals reviewing those lessons.

One particularly relevant case examined a facility that reduced psychotropic medication use by 40%. Psychotropic medicines include antipsychotics, sedatives, hypnotics and some other drugs prescribed to influence mood, behaviour or distress. They can have a legitimate clinical role, but routine use may increase risks such as falls, confusion, excessive sedation, loss of mobility and reduced social participation.

For Australian residential aged-care services, this example is timely. Facilities in Melbourne, Sydney, Brisbane and regional communities are managing residents with dementia, complex health conditions and histories of trauma, while working within tighter expectations around informed consent, medication review, clinical governance and quality of life. A reduction in prescriptions is valuable, but the deeper lesson is how a whole team changes its approach to distress and behaviour.

The Japanese experience also matters because medication reduction rarely succeeds through a single instruction from management. It depends on nurses, personal care workers, visiting GPs, pharmacists, families and residents sharing observations and agreeing on safer alternatives. The outcome is best understood as a culture change supported by measurement, communication and consistent follow-through.

What the 40 per cent reduction really indicates

A 40 per cent fall in psychotropic use should not be treated as a target to copy without context. The important questions are which medicines were reduced, over what period, for which residents and with what safeguards. A facility might achieve a large numerical change by reviewing short-term prescriptions, while another may focus on long-term antipsychotic use linked to dementia-related behaviours.

The strongest interpretation is that the facility created a reliable deprescribing pathway. Residents were assessed individually, treatment goals were clarified, and staff examined whether a medicine was still providing a meaningful benefit. Regular review helped distinguish an active clinical need from a prescription that had continued simply because no one had revisited it.

For an Australian provider, this approach fits the expectation that medication decisions should be person-centred and clinically justified. A resident in a Perth facility may respond to a quiet garden walk, while someone in a busy inner-Sydney home may need a calmer dining routine. The percentage is useful evidence, but the process behind it is the transferable lesson.

Finding the reasons behind distress

Medication is often used when a resident is distressed, awake at night, calling out, resisting personal care or moving repeatedly through the building. These actions are communication, even when their meaning is difficult to identify. Pain, constipation, urinary infection, hunger, loneliness, fear, unfamiliar staff, poor hearing and overstimulation can all appear as “challenging behaviour”.

The facility’s lesson was to replace reflexive suppression with structured investigation. Staff recorded what happened before an episode, what the person did, how colleagues responded and what happened afterwards. Over time, patterns became clearer. A resident might become agitated during a shower because the water was too hot, or call out in the evening because the lighting and noise triggered confusion.

This method is practical in Australia’s multicultural care workforce, where language, food, faith and family customs can affect how distress is expressed. It is also important when supporting Aboriginal and Torres Strait Islander Elders, for whom connection to culture, Country, family and community may be central to wellbeing. A behaviour chart alone cannot provide that understanding; conversations with residents and trusted family members are essential.

Building a team around the resident

Reducing sedative and antipsychotic medicines requires shared responsibility. Personal care workers usually notice subtle changes first, nurses coordinate immediate assessment, and GPs or nurse practitioners make prescribing decisions. Pharmacists can identify interactions, duplicate therapy and gradual dose-reduction opportunities. Families contribute knowledge about the resident’s routines, values and previous coping strategies.

The Japanese facility demonstrated the value of regular case discussions rather than isolated medication reviews. A short meeting can ask what has changed, whether the current care plan is working, what non-drug strategies were tried and when the next review will occur. This gives frontline staff a voice and prevents medication decisions from becoming a private conversation between a prescriber and a chart.

That model suits the Australian market, where residential providers often rely on contracted GPs, community pharmacies and visiting allied-health professionals. In regional Queensland, the challenge may be distance and limited clinician availability; in metropolitan Victoria, it may be coordinating many providers across a large service. Clear records and agreed escalation pathways help maintain continuity when the roster changes.

Replacing medicines with meaningful support

Deprescribing is safer when staff have practical alternatives. These may include personalised music, familiar objects, exercise, outdoor access, hand massage, meaningful household tasks, hydration rounds, improved sleep routines and pain management. Activities work best when they reflect a person’s history rather than being offered as generic entertainment.

A resident who once worked on a farm may settle while watering plants or sorting tools. Someone who enjoyed cooking may engage with afternoon meal preparation. A former shopkeeper might respond to arranging goods or greeting visitors. In an Australian home, a shaded courtyard, a cuppa with a regular carer or a walk to the local library can be more effective than an abstract activity schedule.

The facility’s experience suggests that these approaches must be available at the moment distress occurs. If the only response is to wait for a nurse to administer a tablet, staff will continue to depend on medication. If every team member knows how to offer reassurance, modify the environment and seek clinical review, residents have a wider range of safe support.

Measuring safety and quality of life

A reduction in medication should be accompanied by measures of falls, sleep, pain, weight, hospital transfers, distress episodes and participation in daily life. Teams should also track withdrawal effects, recurrence of severe symptoms and any emergency use of medicines. A lower prescription rate is not a success if residents become frightened, unsafe or unable to rest.

Review meetings can combine numerical data with resident and family feedback. Ask whether the person is more alert at breakfast, joining activities, walking more confidently or communicating more easily. These observations often show benefits that a medication chart cannot capture. They also reveal when a plan needs adjustment.

Australian services should connect this work with existing clinical governance, quality systems and medication-management processes. The goal is not to remove treatment because it looks undesirable on paper. It is to ensure that each medicine has a current purpose, a review date, informed consent and a balance of benefits and risks that remains acceptable to the resident.

Turning conference learning into daily practice

The JS Festival also showed why professional events matter beyond their formal presentations. Study tours and conversations with practitioners allow attendees to see how a policy operates in real rooms, with real staffing pressures. Exhibitions can introduce monitoring tools, sensory products and communication resources, but purchasing equipment should follow a clear care need rather than the excitement of a trade display. The event’s exhibitor materials guide is relevant to suppliers presenting solutions to aged-care decision-makers.

For Australian organisations, the most useful next step is a small, well-defined pilot. Choose one wing or resident group, establish a baseline, review selected medicines with prescribers and test several non-drug interventions. Include care workers in the design, because a plan that cannot be delivered on a Sunday night will not produce lasting results.

Practical steps for an aged-care medication review

The event secretariat remains the appropriate point for enquiries about the past conference, its programme and related materials, and details are available through the event secretariat. The enduring message from the Tochigi case is clear: safer medication use grows from careful assessment, strong relationships and a care environment designed to meet human needs before reaching for a prescription.